Abstract
Two patients with deep-seated arteriovenous malformation (AVM) were treated by intraoperative liquid embolizations due to repeated hemorrhagic episodes. In the first case, with AVM in the head of the caudate nucleus, a frontotemporal craniotomy was performed. After the microsurgical dissection of the feeders, several anterior perforating arteries originating in the anterior cerebral artery (A1 portion) and middle cerebral artery (M1 portion), one of the feeders was canulated with a small-caliber polyethylene catheter, 0.6mm in outer diameter and 0.3mm in inner diameter. A small amount of isobutyl 2-cyanoacrylate (IBCA) was injected through the catheter. This procedure was repeated twice. In addition, a second intraoperative embolization was carried out because of incomplete obliteration. Although the right hemiparesis was slightly deteriorated, the AVM almost completely disappeared after the second operation. In the second case, with an AVM which involved almost the entire thalamus, a subtemporal craniotomy was done. Feeding vessels which originated in the posterior communicating artery and the posterior cerebral artery (PCA) were carefully dissected, and one of them was prepared for canulation with a small catheter. When a small amount of IBCA was injected, the proximal PCA and the internal carotid artery were temporarily occluded. The procedure was performed twice. One month later another intraoperative embolization was carried out. After the second operation the size of the AVM was decreased to 30%. However, left hemiparesis and visual disturbance were noted, although they gradually improved. No hemorrhagic episode has been experienced for two years and eight months in each case after embolization.
